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In this episode, I’ll discuss why steroids are given in myxedema coma.
Myxedema coma is severe hypothyroidism with altered mental status and hypothermia that progresses to coma and death without treatment. Beyond treatment with thyroid hormones, initial treatment recommendations are to also give the patient hydrocortisone 100 mg IV every 8 hours.
In severe hypothyroidism, the pituitary-adrenal system is impaired, and circulating cortisol levels may be low upon presentation. However, a second reason is that the act of giving thyroid hormone replacement to a patient with myxedema will quickly begin to restore their normal metabolic function. Since the patient’s adrenal system is already depressed, this restoration of metabolism may precipitate a state of adrenal insufficiency.
Several of the features of adrenal insufficiency overlap with those of myxedema such as hypotension and hyponatremia. Therefore failure to treat or prevent adrenal insufficiency in a patient with myxedema can worsen the patient’s symptoms or make things appear like the patient is not responding to thyroid hormone treatment.
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